Test Code PNCSU
Pain Clinic Survey, Urine

Secondary ID

Useful For

This test is intended to be used in a setting where the test
results can be used to make a definitive diagnosis.

Profile Information

Test ID

Reporting Name

Available Separately

Always Performed

ADULT

Adulterants Survey, U

Yes

Yes

TOPSU

Targeted Opioid Screen, U

Yes

Yes

PNRCH

Pain Clinic Immunoassay Panel,
U

No

Yes

Reflex Tests

Test ID

Reporting Name

Available Separately

Always Performed

AMPHU

Amphetamines Confirmation, U

Yes

No

COKEU

Cocaine and metabolite Conf, U

Yes

No

BENZU

Benzodiazepines Confirmation,
U

Yes

No

BARBU

Barbiturates Confirmation, U

Yes

No

PCPU

Phencyclidine Confirmation, U

Yes

No

THCU

Carboxy-THC Confirmation, U

Yes

No

Testing Algorithm

Testing begins with an adulterant survey. If the sample is found
to be adulterated, testing will end, and the remaining tests will
be canceled. If sample is normal or only diluted, remaining testing
will continue. If immunoassay screen is positive, confirmation is
performed. Confirmation with quantification of positives for
amphetamines, barbiturates, benzodiazepines, cocaine and
metabolites, phencyclidine, and tetrahydrocannabinol metabolite
will be performed at an additional charge.

Specimen Minimum Volume

20 mL

Specimen Stability Information

Specimen Type

Temperature

Time

Urine

Refrigerated (preferred)

14 days

Frozen

14 days

Ambient

72 hours

Reject Due To

Hemolysis

NA

Lipemia

NA

Icterus

NA

Other

NA

Clinical Information

This test uses the simple screening technique that involves
immunologic testing for drugs by class. All positive immunoassay
screening results are confirmed by gas chromatography-mass
spectrometry (GC-MS) or liquid chromatography-tandem mass
spectrometry (LC-MS/MS), and quantitated, before a positive result
is reported.

This assay was designed to test for and confirm by the
following:

-Barbiturates

-Benzodiazepines

-Cocaine

-Phencyclidine

-Tetrahydrocannabinol

Confirmation by LC-MS/MS is completed for all amphetamines.

The targeted opioid screen portion is performed by liquid
chromatography-tandem mass spectrometry, high-resolution accurate
mass (LC-MS/MS HRAM) and is completed for all opioids. Opioids are
a large class of medications commonly used to relieve acute and
chronic pain or help manage opioid abuse and dependence.
Medications that fall into this class include: buprenorphine,
codeine, fentanyl, hydrocodone, hydromorphone, methadone, morphine,
oxycodone, oxymorphone, tapentadol, tramadol, and others. Opioids
work by binding to the opioid receptors that are found in the
brain, spinal cord, gastrointestinal tract, and other organs.
Common side effects include drowsiness, confusion, nausea,
constipation, and in severe cases respiratory depression depending
on the dose. These medications can also produce physical and
psychological dependence and have a high risk for abuse and
diversion, which is one of the main reasons many professional
practice guidelines recommend compliance testing in
patientsâ€™ prescribed these medications.

Opioids are readily absorbed from the gastrointestinal tract,
nasal mucosa, lungs, and after subcutaneous or intermuscular
injection. Opioids are primarily excreted from the kidney in both
free and conjugated forms. This assay doesnâ€™t
hydrolyze the urine sample and looks for both parent drugs and
metabolites (including glucuronide forms). The detection window for
most opioids in urine is approximately 1 to 3 days with longer
detection times for some compounds (ie, methadone).

Reference Values

ADULT:

Normal

Cutoff concentrations

Oxidants: 200 mg/L

Nitrites: 500 mg/L

PNRCH:

Negative

Screening cutoff concentrations:

Amphetamines: 500 ng/mL

Barbiturates: 200 ng/mL

Benzodiazepines: 100 ng/mL

Cocaine (benzoylecgonine-cocaine metabolite): 150 ng/mL

Phencyclidine: 25 ng/mL

Tetrahydrocannabinol carboxylic acid: 50 ng/mL

This report is intended for use in clinical monitoring or
management of patients. It is not intended for use in
employment-related testing.

TOPSU:

Not Detected

Cutoff concentrations:

Codeine: 25 ng/mL

Codeine-6-beta-glucuronide: 100 ng/mL

Morphine: 25 ng/mL

Morphine-6-beta-glucuronide: 100 ng/mL

6-monoacetylmorphine: 25 ng/mL

Hydrocodone: 25 ng/mL

Norhydrocodone: 25 ng/mL

Dihydrocodeine: 25 ng/mL

Hydromorphone: 25 ng/mL

Hydromorphone-3-beta-glucuronide: 100 ng/mL

Oxycodone: 25 ng/mL

Noroxycodone: 25 ng/mL

Oxymorphone: 25 ng/mL

Oxymorphone-3-beta-glucuronide: 100 ng/mL

Noroxymorphone: 25 ng/mL

Fentanyl: 2 ng/mL

Norfentanyl: 2 ng/mL

Meperidine: 25 ng/mL

Normeperidine: 25 ng/mL

Naloxone: 25 ng/mL

Naloxone-3-beta-glucuronide: 100 ng/mL

Methadone: 25 ng/mL

EDDP: 25 ng/mL

Propoxyphene: 25 ng/mL

Norpropoxyphene: 25 ng/mL

Tramadol: 25 ng/mL

O-desmethyltramadol: 25 ng/mL

Tapentadol: 25 ng/mL

N-desmethyltapentadol: 50 ng/mL

Tapentadol-beta-glucuronide: 100 ng/mL

Buprenorphine: 5 ng/mL

Norbuprenorphine: 5 ng/mL

Norbuprenorphine glucuronide: 20 ng/mL

Interpretation

A positive result derived by this testing indicates that the
patient has used 1 of the drugs detected by these techniques in the
recent past. See individual tests (eg, AMPHU / Amphetamines
Confirmation, Urine) for more information.